Testosterone replacement therapy is widespread

But anti-aging claims have not been tested

August 19, 2002|By NEW YORK TIMES NEWS SERVICE

Last month, the federal government halted a major study of hormone replacement therapy in healthy women, saying the treatment under study seemed to do more harm than good. But while that action generated headlines and alarm, few people noticed just a few weeks earlier when the government decided not to go ahead with a different study of hormone replacement - in older men.

The hormone is testosterone, and its use is soaring. Doctors wrote 1.5 million prescriptions for testosterone and drugs like it in 2001, up from 806,000 in 1997. The hormone has been trumpeted in a variety of media, including advertising in the back pages of fitness magazines and the covers of Time and Newsweek, as a possible antidote for aging and a way to get a lean and muscular body.

But while the theory is that testosterone helps counter the effects of aging - bone and muscle loss, diminished libido - those effects have never been demonstrated in a large clinical trial. As a result, medical experts say, men taking the drug are participating in what amounts to a vast, uncontrolled medical experiment.

The case for testosterone replacement rests on age-old observations: As men grow old, their testosterone levels decline. At the same time, they lose muscle and bone, their sex drive dwindles, and they may experience depression or failing memory.

In younger men with medical conditions that rob them of testosterone, such symptoms disappear when they get the drug. So, some doctors ask, why not give it to older men too?

But testosterone can fuel the growth of prostate cancer, and it increases red blood cell production, possibly increasing the risk of clots that can cause heart attacks and strokes. Those risks, along with concerns about the cost, prompted the government in late June to scuttle a proposed six-year study of testosterone replacement. In the absence of such a study, answers about testosterone's risks and benefits may be a long time coming.